title: Nonsurgical treatment of lumbar disk herniation: are outcomes different in older adults?
abstract: OBJECTIVE
  To determine whether older adults (aged ≥ 60) experience less improvement in disability and pain with nonsurgical treatment of lumbar disk herniation (LDH) than younger adults (< 60).
  
  
  METHODS
  Prospective longitudinal comparative cohort study.
  
  
  METHODS
  Outpatient specialty spine clinic.
  
  
  METHODS
  One hundred thirty-three consecutive patients with radicular pain and magnetic resonance-confirmed acute LDH (89 younger, 44 older).
  
  
  METHODS
  Nonsurgical treatment customized for the individual patient.
  
  
  METHODS
  Patient-reported disability on the Oswestry Disability Index (ODI), leg pain intensity, and back pain intensity were recorded at baseline and 1, 3, and 6 months. The primary outcome was the ODI change score at 6 months. Secondary longitudinal analyses examined rates of change over the follow-up period.
  
  
  RESULTS
  Older adults demonstrated improvements in ODI (range 0-100) and pain intensity (range 0-10) with nonsurgical treatment that were not significantly different from those seen in younger adults at 6 month follow-up, with or without adjustment for potential confounders. Adjusted mean improvement in older and younger adults were 31 versus 33 (P = .63) for ODI, 4.5 versus 4.5 (P = .99) for leg pain, and 2.4 versus 2.7 for back pain (P = .69). A greater amount of the total improvement in leg pain and back pain in older adults was noted in the first month of follow-up than in younger adults.
  
  
  CONCLUSIONS
  These preliminary findings suggest that the outcomes of LDH with nonsurgical treatment were not worse in older adults (≥ 60) than in younger adults (< 60). Future research is warranted to examine nonsurgical treatment for LDH in older adults.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA. psuri@caregroup.harvard.edu
authors.forename: Pradeep
authors.initials: P
authors.lastname: Suri
authors.forename: David J
authors.initials: DJ
authors.lastname: Hunter
authors.forename: Cristin
authors.initials: C
authors.lastname: Jouve
authors.forename: Carol
authors.initials: C
authors.lastname: Hartigan
authors.forename: Janet
authors.initials: J
authors.lastname: Limke
authors.forename: Enrique
authors.initials: E
authors.lastname: Pena
authors.forename: Ling
authors.initials: L
authors.lastname: Li
authors.forename: Jennifer
authors.initials: J
authors.lastname: Luz
authors.forename: James
authors.initials: J
authors.lastname: Rainville
mesh_terms: D000368:Aged; D004185:Disability Evaluation; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000628:therapy*; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010808:Physical Examination; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome